By Stephanie A. Kennan

While the Trump campaign was not always specific about the policies or goals for health policy, the expected changes in many areas could be a reverse of the last four years of the Biden administration.

Two overarching polices that are not specific to health may impact the sector. The Trump administration is likely to shrink the size of federal agencies and substantially reorganize existing staff. How fast these changes can be made is unclear. This reorganization could impact operations of health agencies if experienced civil servants are not there. Tariffs are another area that could impact the health sector. Trump has pledged to impose tariffs. Some in the hospital sector have raised concerns that combined with inflation, rising labor costs, decreasing reimbursement and the already high cost of supplies, tariffs will hurt the sector. A health care carve out may be something for which the sector advocates.
Efforts to weaken the Affordable Care Act (ACA) could be similar to those taken in Trump’s first term. Those tactics could include reducing funds for enrollment outreach, limiting the enrollment period, permitting the purchase of more health plans that do not comply with the ACA consumer protections and allowing insurers to charge sicker people higher premiums.
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However, it is unclear if Trump would go along with an extension of the premium tax subsidy that is up for renewal in 2025; many Republicans in Congress oppose an extension. Without the extension, the uninsured rate will rise. Alternatively, some people may enroll in cheaper, less comprehensive plans that do not meet the ACA protections. Advocates fear that if the subsidy is not extended, the funding would be used to pay for other tax cuts.

Republicans have wanted to change Medicaid funding for decades and the Trump administration was no different. In the previous attempt to repeal the ACA, part of the proposal would have capped Medicaid spending and allowed states more “flexibility” in how to spend federal Medicaid funds. The Trump administration also used the Section 1115 waiver process to permit work requirements. Some are now concerned about potential changes in the use of Section 1332 waivers which many states use for marketplace reinsurance.

Drug pricing is an area in which few details have been provided. The president elect has said he would like to lower all health care costs, including drug costs. In his previous administration, Trump began to implement a policy of not paying more than other countries for prescription drugs. That policy was reversed by the Biden administration. However, Trump could also tweak the way in which drugs are negotiated in Medicare or support a repeal of the whole measure, as some Republicans in Congress wish to do. The Trump administration is expected to support some aspects of reform of pharmacy benefit managers, but specifics have not been provided.

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